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Excess Visceral and Hepatic Adipose Tissue in Turner Syndrome Determined by Magnetic Resonance Imaging: Estrogen Deficiency Associated with Hepatic Adipose Content

Department of Endocrinology, University College London Hospitals (J.E.O., M.J.H.A., G.S.C.), London W1T 3AA, United Kingdom; and Robert Steiner Magnetic Resonance Unit, Imaging Sciences Department, Medical Research Council Clinical Sciences Center, Hammersmith Hospital, Imperial College (E.L.T., G.H., J.D.B.), London W12 0HS, United Kingdom

Address all correspondence and requests for reprints to: Dr. Gerard S. Conway, Department of Endocrinology, Middlesex Hospital, Mortimer Street, London W1T 3AA, United Kingdom. E-mail: g.conway{at}ucl.ac.uk.

Obesity, predominantly centrally distributed, is common in women with Turner syndrome (TS) and is thought to contribute to the increased risk of atherosclerosis; however, insulin concentrations are unexpectedly low. To explore this discrepancy, we assessed fat content and distribution by magnetic resonance imaging (MRI) and bioelectrical impedance (BI). Six nondiabetic, estrogen-treated women with TS were compared with six age-matched normal controls of similar body mass index. Clinical history, anthropometric measurements, biochemical markers, and MRI and BI measures of adiposity were assessed. TS women had increased intrahepatocellular lipids (IHCL) on MRI. After height adjustment, they also had an excess of total and visceral compared with sc adipose tissue (AT) than controls, without elevated insulin concentrations. BI and MRI measures correlated strongly for total and sc, but not visceral, AT in TS. IHCL was associated with cumulative estrogen-deficient years (r = 0.928; P = 0.008). Women with TS depart from the classical picture of metabolic syndrome despite an excess of total and visceral AT on MRI. Elevated IHCL in TS is associated with estrogen deficiency. BI may be useful to estimate total body fat, but does not reliably localize fat depots in TS.

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